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Injuries of the shoulder and arm.

A systematic approach to the injured shoulder includes careful history taking and sequential examination of all anatomic components of the shoulder girdle in each and every patient. High quality radiographs, with two views at 90 degrees to one another, are essential. A specific diagnosis can and must be made on every patient with an injured shoulder to enable referral for proper care and follow-up.

Acromioclavicular Joint↗

The national jockey injury study: an analysis of injuries to professional horse-racing jockeys.

While there have been numerous reports in the literature of accidents in equestrian sports, no comprehensive study has been conducted to ascertain the nature and incidence of injuries incurred by professional horse-racing jockeys. A survey was conducted to determine the types of injuries to jockeys and racing-related health concerns, including weight reduction methods. The questionnaire was completed by 706 professional jockeys actively competing at United States racetracks between July and October 1990 about injuries they had sustained in their careers. More than 1,700 injuries were reported. Fractures (n = 1,113) accounted for 64% of the total. The most common cause of injury was becoming unseated, followed by the horse falling. Relationships between characteristics of jockeys and injuries were evaluated. There were significant numbers of serious injuries with prolonged periods of not riding. Recommendations for improving jockey safety are made.

Absenteeism↗

Humeral fractures without obvious etiologies in children less than 3 years of age: when is it abuse?

OBJECTIVE: To determine the occurrence and frequency of abuse in children with humeral fractures without immediately obvious etiologies who are less than 3 years old and present with arm injuries. METHODS: A retrospective chart review was conducted of all children less than 3 years old treated for a humeral fracture at Children's Hospital Medical Center between July 1, 1990, and September 10, 1993. One hundred twenty-four charts of children with humeral fractures were reviewed for possible abuse using previously developed criteria. Charts were evaluated independently by the investigators. Consensus was reached on classification of each chart into the following categories: abuse, indeterminate, or not abuse. RESULTS: Abuse was diagnosed in 9 of 25 (36%) children less than 15 months of age, but in only 1 of 99 (1%) children older than 15 months (P < .05). Abuse was excluded in 91 of 124 (73%) children. No determination of abuse (indeterminate) could be made in 23 of 124 (18.5%) children. In children less than 15 months of age, abuse was diagnosed in 2 of 10 (20%) with supracondylar fractures and in 7 of 12 (58%) with spiral/oblique fractures. CONCLUSION: The prevalence of abuse in our children presenting with humeral fractures was much lower than in other published reports, especially in the children over the age of 15 months. However, we found a higher prevalence of supracondylar fractures associated with abuse than those same reports. Given these findings, abuse should be considered in all children less than 15 months of age with humeral fractures, including those with supracondylar fractures. The majority of humeral fractures in children are accidental, especially beyond the age of 15 months.

Child Abuse↗

Epiphyseal injuries in the growing athlete.

The epiphyses and epiphyseal plates are vital structures in the bone development of the growing athlete. The epiphyseal plate is two to five times weaker than the surrounding fibrous tissue in children and adolescents; consequently a force causing a ligamentous tear in adults is likely to cause an epiphyseal plate injury in growing children. Two types of epiphyseal injury that are common in the growing athlete are (a) separation across the epiphyseal plate, which is usually produced by a direct blow to the joint area or by a strong muscular contraction, and (b) traumatic epiphysitis, the more common of the two, which is usually caused by strong, repetitive contraction of a muscle attached to a traction epiphysis. Each epiphyseal site has specific anatomic features and the forces causing injury differ slightly at each site. An improperly treated separation of an intra-articular pressure epiphysis can have a disastrous effect on the proper functioning of the normally well-fitted articulation of bone ends in the joint. Consequently, proper diagnosis and treatment are essential. Traumatic epiphysitis can result in chronic inflammation or fragmentation, or both, if the condition is not arrested. Therefore the athlete must discontinue the activities that are causing the trauma until the inflammation is completely arrested. Absolute rest may even be required.

Ankle Injuries↗

Dorsal silicone rods in the primary care of war injuries.

During armed combat serious hand injuries are often neglected only to receive the attention they deserve far too late. The authors have employed a vigorous approach to the primary care of severe war injuries to dorsum of the hand introducing silicone rods where extensor tendons have been destroyed and where skin closure is obtained using inguinal skin flaps.

Hand Injuries↗

Missed posterior fracture-dislocation of the humeral head following an electrocution injury to the arm.

Posterior dislocation of the shoulder is a rare and commonly missed injury. While prompt diagnosis and treatment is important to prevent untoward sequelae, it is often diagnosed and treated too late. The first reported case of a posterior fracture-dislocation of the humeral head following a domestic electrocution accident in Singapore is described in a 52-year-old man. The injury was missed by several doctors before a humeral head replacement was done. The diagnostic pitfalls and management of this injury and ways to avoid a missed or delayed diagnosis are discussed.

Electric Injuries↗

Arm wrestler's injury: report of seven cases.

Seven cases of fractures of the humerus from arm wrestling included 2 types of fractures. Two were spiral fractures of the humeral shaft with large butterfly fragments at the junction of the middle and distal one third caused by a violent uncoordinated muscular action. Five were fractures of the medial epicondyle of the humerus as a result of a sudden blow to the elbow. In all 7 cases, the fractures healed and arm function returned to normal.

Adolescent↗